Stroke is the third leading cause of death in the United States and the leading cause of serious long-term disability. Ischemic stroke represents almost 80-85% of strokes and occurs when a blockage or clot develops in one of the arteries supplying blood to the brain. Among the risk factors for stroke is the condition of the heart known as atrial fibrillation (AF), which allows for the development of blood clots to form in the heart, which are then pumped out to the brain to cause a stroke. About 6% of the U.S. Medicare population is estimated to have AF. Based upon statistics that show that the incidence may be increasing in the population, it has been estimated that by 2050, there will be 12 million people with AF. About 15-20% of all ischemic strokes are due to AF. AF increases the risk of stroke by a factor of almost 5. The majority of ischemic strokes can be prevented in AF through the use of anticoagulation, but this carries a not-insignificant risk of hemorrhage.
Paroxysmal AF (PAF) is a form of AF that is particularly vexing for the stroke neurologist and cardiologist, because a patient who suffers from PAF can have a clinical event but there is no evidence of AF upon immediate medical evaluation. Treatment of a patient with a stroke due to AF differs radically from that of a patient without AF. Therefore, identification of AF in a patient with a stroke suggestive of cardioembolic etiology becomes extremely compelling. New methods of outpatient long-term cardiac rhythm monitoring have been developed to assist in the identification of PAF/AF.
Warfarin has been considered the anticoagulant of choice for decades in the treatment of AF. However, warfarin requires a lot of medical follow-up to insure adequate therapeutic levels. This has hampered patient compliance. Newer oral agents are now available on the market that provide adequate anticoagulation without the need for intensive chronic medical follow-up. In addition, in the past few years, several cutting-edge interventional and surgical therapies have been developed for the treatment of AF, including catheter-based therapies and new surgical techniques.
All of these new diagnostic and therapeutic modalities have not yet achieved widespread recognition in the broad medical community. A large component of this year’s conference will be dedicated to addressing various aspects of AF diagnosis and treatment.